[Osborn] chapter 4

Learning Objectives [Number and Title ]

Learning Objective 1 Explain how ethical theories and principles influence nursing practice in a
clinical setting.
Learning Objective 2 Identify and apply the steps of the MO!L "odel in ethical decision
"a#ing.
Learning Objective $ %o"pare and contrast the three distinct structures that ethics co""ittees
de"onstrate in health care institutions.
Learning Objective & Explain how the state nurse practice act governs and guides nursing
practice.
Learning Outco"e ' (istinguish a"ong the types of laws that typically affect nursing practice)
co""on* civil* tort* contract* and cri"inal.
Learning Objective + Identify the six ele"ents of "alpractice law as described in the chapter.
Learning Objective , (iscuss the i"portance of standards of care and how they are
differentiated between internal and external standards.
Learning Objective - (istinguish between regional and national nor"s.
Learning Objective . Identify the three "ost co""on intentional torts and the three "ost
co""on /uasi0intentional torts seen in health care settings and explain the
defenses against the".
Learning Objective 11 Explain the doctrine of infor"ed consent as it relates to the use of i"plied
consent in nursing settings.
Learning Objective 11 Explain actions that the nurse "ay ta#e to avoid or prevent possible
liabilities.
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1. ! patient cries /uietly while undergoing a painful treat"ent. 2he nurse reali3es the treat"ent is
painful4 however* it is necessary for the patient5s healing and recovery. 6hich ethical principle does
this situation exe"plify7
1. 8on"aleficence
2. 9aternalis"
$. :eracity
&. espect for others
%orrect !nswer) 8on"aleficence
ationale) Even though the principle of non"aleficence states that a person should do no har"* the
focus of the projected treat"ent or procedure is on the conse/uences of the benefits to the patient and
not on the har" that occurs at the ti"e of the intervention. 9aternalis" allows one to "a#e decisions
for another. :eracity is the concept that individuals should always tell the truth. espect for others
ac#nowledges the right of individuals to "a#e decisions and to live by those decisions.
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 1
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2. 2he health care tea" is confronted with an ethical dile""a surrounding one patient and the types of
care available. 2he tea" decides to apply ethical principles to deter"ine the best course of action for
this patient. 2his is an exa"ple of which type of ethical theory7
1. 9rinciplis"
2. (eontological
$. 2eleological
&. <tilitarianis"
%orrect !nswer) 9rinciplis"
ationale) 9rinciplis" incorporates existing ethical principles and atte"pts to resolve conflicts by
applying one or "ore of the principles. (eontological theories derive nor"s and rules fro" the duties
hu"an beings owe to one another by virtue of co""it"ents "ade and roles assu"ed. 2eleological
theories derive nor"s or rules for conduct fro" the conse/uences of actions. <tilitarianis" is another
ter" for teleological and can be divided into =rule> and =act> utilitarianis".
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 1
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
$. ! patient as#s the nurse to pro"ise hi" that nothing bad will happen to hi" while he is under
anesthesia for a surgical procedure. 2he patient is creating a conflict in which of the following ethical
principles of the nurse7
1. ?idelity
2. espect for others
$. 9aternalis"
&. :eracity
%orrect !nswer) ?idelity
ationale) ?idelity "eans #eeping one5s pro"ises or co""it"ents. 2he patient is putting the =nurse in
the "iddle> of a potentially conflicting situation. 2he nurse cannot pro"ise that nothing bad will
happen to the patient during anesthesia. espect for others ac#nowledges the right of individuals to
"a#e decisions and to live by these decisions. 9aternalis" allows one person to "a#e decisions for
another. :eracity is the concept that one should always tell the truth.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 1
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
&. ! health care provider is reviewing the steps ta#en to address an ethical issue with a patient. 6ithin
which of the following steps of the MO!L "odel is this health care provider wor#ing7
1. Loo# bac# and evaluate.
2. Massage the dile""a.
$. Outline the options.
&. !ct by applying the selected option.
%orrect !nswer) Loo# bac# and evaluate.
ationale) 2he health care provider is loo#ing bac# and evaluating. 2his is the process of reviewing
and reexa"ining whether desired outco"es were attained and whether new options need to be
i"ple"ented. Massage the dile""a "eans that the issues are identified. Outline the options "eans the
options are fully exa"ined* including those that are less realistic. !ct by applying the selected option
refers to i"ple"entation of the chosen option to resolve the dile""a.
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 2
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
'. 2he health care tea" is "a#ing a list of the ways to resolve the issue of whether or not to continue
life support for a patient. 2he step of the MO!L "odel that the tea" is currently engaged in would
be)
1. Outline the options.
2. !pply the chosen option.
$. esolve the dile""a.
&. Massage the dile""a.
%orrect !nswer) Outline the options.
ationale) 2he second step in the MO!L "odel is outline the options* where the "e"bers of the
health care tea" "a#e a list of all ways to resolve the ethical dile""a of continuing life support.
!pplying the chosen option "eans the action chosen would be i"ple"ented. esolve the dile""a is
the third step in which ethical principles are applied to each of the identified options. Massage the
dile""a is the first step in the "odel and is where all of the issues are identified.
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 2
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
+. 2he fa"ily of a ter"inally ill patient tells the nurse that a certain level of care is to be provided to
the patient. 2he health care staff is /uestioning the value of providing the care and believes so"ething
else should be done. 6hich of the following should be done first for this situation7
1. Massage the dile""a.
2. Outline the options.
$. esolve the dile""a.
&. !pply an option to resolve the dile""a.
%orrect !nswer) Massage the dile""a.
ationale) ! new health0care0related issue has surfaced. 2he fa"ily wants one course of action* and
the health care professionals want another. 2he ethical issue needs to be "assaged* identified* and
defined before the options can be outlined. 2he tea" is not prepared to resolve the dile""a or apply
any solutions until the actual dile""a is defined.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 2
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
,. ! patient is having a difficult ti"e deciding whether or not to accept an experi"ental treat"ent for a
health proble". 2he health care tea" is planning to discuss this patient5s issue at the next co""ittee
"eeting. 2he co""ittee structure that would support this patient5s dile""a is the)
1. !utono"y "odel.
2. 9atient benefit "odel.
$. ;ocial justice "odel.
&. !ccountability "odel.
%orrect !nswer) !utono"y "odel.
ationale) 2he autono"y "odel supports ethical decision "a#ing for the co"petent patient. 2he
patient benefit "odel facilitates decision "a#ing for the inco"petent patient. 2he social justice "odel
considers broad social issues that "ay arise within an organi3ation. 2he accountability "odel is not an
identified ethics co""ittee structure.
%ognitive Level) !naly3ing
8ursing 9rocess) 9lanning
%lient 8eed) ;afe* Effective %are Environ"ent
LO) $
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
-. ! patient* agreeing to receive care for a ter"inal illness* is experiencing the side effect of confusion
fro" the treat"ent. If the health care providers follow the patient benefit "odel of ethical care* which
of the following would be done7
1. (eter"ine if the patient would want to be confused and then either proceed or stop the
treat"ent.
2. %ontinue with the treat"ent because the patient "ade the decision.
$. %ontinue the treat"ent because other patients "ight find out that the hospital does not
provide re/uired care.
&. ?ind health care providers willing to provide the care even though the patient is confused.
%orrect !nswer) (eter"ine if the patient would want to be confused and then either proceed or stop
the treat"ent.
ationale) 2he patient benefit "odel uses substituted judg"ent* which ta#es into consideration what
the patient would want done if capable of "a#ing the decision. 2he staff should deter"ine if the
patient would want to be confused and then either proceed or stop the treat"ent. %ontinuing with the
treat"ent does not ta#e into consideration the patient5s change in "ental status and is a decision that
would be "ade if following the autono"y "odel. %ontinuing with the treat"ent because of other
patients5 /uestioning the hospital5s ability to provide care would be an outco"e fro" i"ple"enting the
social justice "odel. ?inding health care providers willing to provide the care even though the patient
is confused is not an exa"ple of an ethics co""ittee decision.
%ognitive Level) !pplying
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) $
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
.. 6hile providing care to a patient* an ethical issue is discovered. 2he nurse* recalling a si"ilar
situation fro" attending ethical grand rounds* provides an intervention that resolves the dile""a
without further action re/uired. 6hich of the following types of ethical co""ittee structure helped the
nurse and patient resolve the ethical dile""a7
1. ;ocial justice "odel
2. @lend of autono"y and patient benefit "odels
$. !utono"y "odel
&. 9atient benefit "odel
%orrect !nswer) ;ocial justice "odel
ationale) 2he social justice "odel considers broad social issues* and "any ethics co""ittees hold
ethical grand rounds based on this structure. In ethical grand rounds* broad issues are reviewed and
discussed* which helps nurses "a#e /uic# and co"petent decisions about the sa"e issue in the future.
2here is no evidence to suggest that the patient was incapable of "a#ing a decision* which the patient
benefit "odel would support. 2he autono"y "odel facilitates decision "a#ing for a co"petent
patient4 however* in this situation* the nurse used infor"ation gained fro" an ethical grand rounds
progra".
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) $
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
11. 2he nurse received an update fro" the state board of nursing about a new continuing education
re/uire"ent. 6hich of the following should the nurse do with this infor"ation7
1. 9lan to learn "ore about the re/uire"ent to be in co"pliance.
2. 8othing. It is only fro" the board of nursing.
$. %ontact the !"erican 8urses !ssociation about the re/uire"ent.
&. !s# a health care provider if the re/uire"ent is necessary to nursing practice.
%orrect !nswer) 9lan to learn "ore about the re/uire"ent to be in co"pliance.
ationale) 2he state board of nursing is an exa"ple of an ad"inistrative law agency. !d"inistrative
laws are enacted through the decisions and rules of ad"inistrative agencies* which are specific
governing bodies charged with i"ple"enting selected legislation. 2he nurse practice act is an exa"ple
of statutory law. ;tatutory laws are those rules and regulations enacted by the legislative branch of the
govern"ent. 6hen statutory laws are enacted* ad"inistrative agencies are given the authority to
i"ple"ent the specific intentions of the statutes* creating rules and regulations that enforce the
statutory law. 2he nurse needs to plan to learn "ore about the re/uire"ent. 2he nurse should not
ignore the notice. 2he nurse does not need to contact the !"erican 8urses !ssociation or as# a health
care provider if the re/uire"ent is necessary.
%ognitive Level) !naly3ing
8ursing 9rocess) 9lanning
%lient 8eed) ;afe* Effective %are Environ"ent
LO) &
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
11. ! nurse is found to have a che"ical0dependency issue. 2his infor"ation is to be co""unicated to
the)
1. ;tate board of nursing.
2. !"erican 8urses !ssociation.
$. 9olice.
&. ;chool of nursing fro" which the nurse graduated.
%orrect !nswer) ;tate board of nursing.
ationale) 2he state board of nursing should be notified because the act "ay also include infor"ation
on how to help nurses affected by addictions. 2he !"erican 8urses !ssociation is not going to
provide help for nurses with addictions. 2he police should not be notified unless the nurse participated
in so"e illegal activity. 2he school of nursing fro" which the nurse graduated does not need to be
infor"ed of the nurse5s che"ical0dependency issue.
%ognitive Level) !pplying
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) &
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
12. ! patient says that he doesn5t want the nurse to re"ove the 9I%% line fro" his ar" because the last
ti"e he had one* the doctor told hi" that it was so"ething that only a doctor can do. 6hich of the
following would be the "ost appropriate response to this patient7
1. =2he nurse practice act for this state includes this s#ill as a nursing activity and I have been
trained on the correct way to re"ove it.>
2. =I will get the doctor.>
$. =!re you refusing to have the 9I%% line re"oved7>
&. =I can tal# you through re"oving it yourself.>
%orrect !nswer) =2he nurse practice act for this state includes this s#ill as a nursing activity and I have
been trained on the correct way to re"ove it.>
ationale) 2he nurse has had an expansion of her role and has been trained on the activity. 2he correct
response is to explain that the activity is covered within the nurse practice act and the nurse has been
found co"petent to perfor" the activity. It is not necessary for the nurse to get the doctor* nor should
the nurse confront the patient by assu"ing the patient refuses to have the line re"oved. 2al#ing the
patient through the procedure to re"ove the line hi"self is not a viable safe option.
%ognitive Level) !pplying
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) &
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1$. ! patient is telling the nurse "anager that she believes a wrongful act occurred when she was
given the wrong "edication. 2he law to address this issue would be considered)
1. 2ort.
2. %o""on.
$. %ivil.
&. %ri"inal.
%orrect !nswer) 2ort.
ationale) ! tort is a wrongful act co""itted against another person or the person5s property. 2hese
wrongful acts result in an injury or har"* thereby constituting the basis for a clai" by the injured
party. !lthough so"e torts are cri"es punishable by i"prison"ent* the pri"ary ai" of tort law is to
provide relief for the da"ages incurred and to deter others fro" co""itting the sa"e har"s. 2he
injured person "ay sue for an injunction to prevent the continuation of the tortuous conduct or for
"onetary da"ages. %o""on law is derived fro" principles rather than rules and regulations.
%o""on law is based on justice* reason* and co""on sense. It represents law "ade by judges through
decisions in specific cases. %ivil law begins with abstract rules* which judges "ust then apply to cases.
%ri"inal law is public law that involves the prosecution by the govern"ent of a person for an act that
has been classified as a cri"e.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) '
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
14. ! patient5s personal health infor"ation was provided to another individual without the patient5s
per"ission. 2he nurse reali3es this breach of infor"ation would be addressed by which of the
following types of laws7
1. 2ort
2. %ivil
$. %o""on
&. %ontract
%orrect !nswer) 2ort
ationale) ! tort is a wrongful act co""itted against another person or the person5s property. !n
exa"ple of a tort action is a breach of confidentiality. %ivil law is defined as laws "ade fro" abstract
rules and applied to situations. %o""on law is a syste" of law derived fro" the decisions of judges.
%ontract law addresses the issues about agree"ents "ade between two parties.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) '
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1'. ! patient tells the nurse that he had "oney in the top drawer of his bedside table that is now
"issing. Ae is phoning his attorney and plans to press charges. 2he nurse reali3es this patient is
planning to i"ple"ent which of the following types of law7
1. %ri"inal
2. 2ort
$. %o""on
&. %ontract
%orrect !nswer) %ri"inal
ationale) %ri"inal law involves the prosecution by the govern"ent of a person for an act that has
been classified as a cri"e. 2he patient is clai"ing that "oney was stolen* which is a cri"e. ! tort is a
wrongful act co""itted against another person or the person5s property. 2he pri"ary ai" of tort law is
to provide relief for da"ages. %o""on law is a syste" of law that is derived fro" judges5 decisions.
%ontract law is a way to govern a pro"ise or agree"ent that has been "ade between two parties.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) '
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1+. ! patient leaves the hospital without receiving his "edication prescriptions and discharge
instructions* which causes the patient to sustain physical har". 2he hospital should be concerned about
which of the following ele"ents of "alpractice7
1. Injury
2. (uty
$. @reach of duty
&. %ausation
%orrect !nswer) Injury
ationale) Injury "eans that actual har" results to the patient. !n exa"ple of this would be failing to
provide patient education and discharge planning. (uty "eans care is provided according to what a
prudent nurse would have done. @reach of duty is not giving the care that should be given to a patient.
%ausation "eans the patient was har"ed because proper care was not given.
%ognitive Level) !naly3ing
8ursing 9rocess) 9lanning
%lient 8eed) ;afe* Effective %are Environ"ent
LO) +
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1,. ! patient with an elevated blood glucose level was given 111 units of regular insulin when the
order was written for the patient to receive 11.1 units of regular insulin. 2he patient5s blood glucose
level dropped to &1 "gBdl* re/uiring additional "edical intervention to stabili3e. 2he inappropriate
a"ount of insulin this patient received would be considered as which ele"ent of "alpractice7
1. %ausation
2. @reach of duty
$. ?oreseeability of har"
&. (uty
%orrect !nswer) %ausation
ationale) %ausation "eans that a direct relationship exists between the failure to "eet the standard of
care and an injury. 2he patient is har"ed because proper care is not given. In this situation* the patient
received 11 ti"es the prescribed a"ount of insulin* which dropped the blood glucose level down to &1
"gBdl* a dangerously low level. 2he patient then needed additional "edical intervention to stabili3e.
(uty owed the patient is care that any prudent nurse would have done. 2he nature of the duty
represents the "ini"u" re/uire"ents that define acceptable or standard care. @reach of duty would be
not giving the care that should be given under the circu"stances. ?oreseeability of har" "eans the
nurse needed to have access to infor"ation about whether the possibility of har" exists.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) +
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1-. ! patient has proven that a hospital e"ployee was negligent when providing care. 2he nurse
reali3es that the outco"e of this decision would result in which of the following7
1. (a"ages
2. Injury
$. %ausation
&. ?oreseeability of har"
%orrect !nswer) (a"ages
ationale) (a"ages is the final step in the ele"ents of "alpractice. 2he patient "ust prove that
financial har" occurred while hospitali3ed. Injury is the fifth ele"ent of "alpractice and "eans that
physical injury occurred and not psychological or transient injury. %ausation is the fourth ele"ent of
"alpractice and "eans that an action or lac# of action directly caused har". ?oreseeability of har" is
the third ele"ent of "alpractice and "eans that certain events "ay reasonably be expected to cause
specific results.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) +
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
1.. 2he parents of a stillborn baby are suing the hospital for "alpractice. 6hich of the following
standards would "ost li#ely be consulted for this case7
1. 8eonatal 8ursing) ;cope and ;tandards of 9ractice
2. Ao"e Aealth 8ursing) ;cope and ;tandards of 9ractice
$. 9ublic Aealth 8ursing) ;cope and ;tandards of 9ractice
&. ;cope and ;tandards of 9ractice for 8ursing 9rofessional (evelop"ent
%orrect !nswer) 8eonatal 8ursing) ;cope and ;tandards of 9ractice
ationale) ;everal sources can be used to deter"ine the applicable standard of care. 2he !"erican
8urses !ssociation* as well as a cadre of specialty organi3ations* publishes standards for nursing
practice. 2he overall fra"ewor# of these external standards is the nursing process. !dditional
standards have been published that describe nursing care for a variety of patient populations and in
selected nursing settings. ;ince this situation is about a baby* the standards about ho"e health* public
health* and professional nursing develop"ent would not apply.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) ,
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
21. 2he nurse is not sure which approach to ta#e when providing one aspect of care to a patient. 6hich
of the following should the nurse do7
1. %hec# the organi3ation5s procedure "anual to find out the standard of practice for the care.
2. ;earch for a "aga3ine article that discusses the aspect of care.
$. !s the health care provider what should be done about the care.
&. (ocu"ent that the patient refused the one aspect of care.
%orrect !nswer) %hec# the organi3ation5s procedure "anual to find out the standard of practice for the
care.
ationale) ;tandards of care are established by reviewing the organi3ation5s policy and procedure
"anual. ;earching for a "aga3ine article about the aspect of care "ight be done but it "ay not
coincide with the organi3ation5s policy and procedure "anual. 2he nurse should not as# the health care
provider what should be done about the care. 2he nurse should not falsely docu"ent that the patient
refused one aspect of care.
%ognitive Level) !pplying
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) ,
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
21. 2he nurse is considering "oving into the role of providing care to ter"inally ill patients. 6hich of
the following scope and standards of practice would the nurse review to learn the "ost infor"ation
about the care provided to these types of patients7
1. Aospice and 9alliative 8ursing
2. 9ain Manage"ent 8ursing
$. adiology 8ursing
&. Ao"e Aealth 8ursing
%orrect !nswer) Aospice and 9alliative 8ursing
ationale) 2he !"erican 8urses !ssociation has published "any different types of scopes and
standards for nursing practice. 2he one that would be the "ost applicable to the care of a ter"inally ill
patient would the standards to address Aospice and 9alliative 8ursing. 9ain Manage"ent "ight
provide infor"ation as well as Ao"e Aealth 8ursing. adiology 8ursing is the one that would
provide the least a"ount of infor"ation.
%ognitive Level) !naly3ing
8ursing 9rocess) 9lanning
%lient 8eed) ;afe* Effective %are Environ"ent
LO) ,
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
22. ! patient co"es into a s"all co""unity hospital e"ergency depart"ent with a severely lacerated
hand. !fter appropriate treat"ent* the patient receives nursing care based upon docu"ented standards
of care so that the hand will function well with "ini"al scarring. 2his standard of practice would be
considered aCnD)
1. 8ational nor".
2. Internal standard.
$. External standard.
&. egional nor".
%orrect !nswer) 8ational nor"
ationale) 8ational standards of care are based on reasonableness and are the average degree of s#ill*
care* and diligence exercised by "e"bers of the sa"e profession. ;uch national standards "ean that
nurses in all settings* urban and rural* "ust "eet the sa"e standards when caring for patients in
clinical settings. 8ational standards of care have slowly replaced the previously used regional or
locality standard of care* which allowed the standard of care to be viewed fro" the perspective of care
within a given geographical area or =si"ilar co""unity.> 2he only way of #nowing if this practice is
an internal standard would be to review the co""unity hospital5s policy and procedure "anual. 2he
only way of #nowing if this practice is an external standard would be to review published "aterials
regarding the care of the patient with a severely lacerated hand.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) -
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2$. ! patient as#s the nurse why bottled water is being used to flush her wound when she was told to
use tap water at ho"e. 2he nurse reali3es this patient is describing which of the following7
1. ! regional standard of care
2. ! national standard of care
$. !n infection control "easure
&. ! cost contain"ent "easure
%orrect !nswer) ! regional standard of care
ationale) egional standards of care are those standards viewed fro" a given geographical area or
si"ilar co""unity. 2he patient using tap water to flush a wound was "ost li#ely a regional standard
of care. ! national standard is that which is done by nurses in all settings. <sing tap water would not
be an infection control "easure. 2here is no way of #nowing if the patient needed to use tap water as a
cost contain"ent "easure.
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) -
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2&. 2he nursing staff fro" a co""unity hospital is attending a conference to learn how to use a closed
chest tube collection device instead of the previously used glass bottle with '11 cc of sterile water. 2he
nurse reali3es this conference ensures that all nurses will practice chest tube care according to)
1. 8ational standards of care.
2. 2he Eoint %o""ission provision of care accreditation standards.
$. %ost0effective "ethods.
&. 8ational 9atient ;afety goals.
%orrect !nswer) 8ational standards of care.
ational) 8ational standards of care are based on reasonableness and are the average degree of s#ill*
care* and diligence exercised by "e"bers of the sa"e profession. Educational progra"s "a#e it easier
for all individuals of a profession to learn the standards so that all patients receive the highest /uality
of care* regardless of location. 2he Eoint %o""ission5s provisions of care standards and the 8ational
9atient ;afety goals do not specifically address chest tube care. 2he closed chest tube collection device
"ay or "ay not be a cost0effective "ethod.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) -
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2'. ! patient clai"s that fa"ily "e"bers had access to his "edical record and believes that he has had
a breach of confidentiality. 2his breach would be considered a part of)
1. Invasion of privacy
2. !ssault
$. @attery
&. (efa"ation of character
%orrect !nswer) Invasion of privacy
ationale) !n exa"ple of a breach of confidentiality is the invasion of privacy that is considered a
/uasi0intentional tort. !ssault and battery are exa"ples of intentional torts. (efa"ation of character is
a /uasi0intentional tort with the intention of har"ing another person5s reputation.
%ognitive Level) !naly3ing
8ursing 9rocess) !ssess"ent
%lient 8eed) ;afe* Effective %are Environ"ent
LO) .
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2+. 2he nurse who tells the patient that she is discharged but not allowed to leave the hospital yet and
ta#es the patient5s purse is at ris# for which of the following intentional torts7
1. ?alse i"prison"ent
2. (efa"ation of character
$. Invasion of privacy
&. @reach of confidentiality
%orrect !nswer) ?alse i"prison"ent
ationale) ?alse i"prison"ent is the unjustified detention of a person without the legal right to confine
the person and "ay occur if the act is directed at the patient5s possessions such as a purse. (efa"ation
of character is har"ing another5s reputation by di"inishing the estee"* respect* or goodwill that others
have for that person. Invasion of privacy is a violation of a person5s right to protection against
unwarranted interference into their personal life. @reach of confidentiality is a type of invasion of
privacy that has to do with infor"ation within the patient5s "edical record.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) .
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2,. ! patient* who is a local elected public official* is ad"itted with a che"ical dependency. 2he nurse
tells a visitor that the patient is a cocaine user. 6hich of the following has the nurse done7
1. Invaded the patient5s privacy
2. @reached the patient5s confidentiality
$. !ssaulted the patient
&. 9rovided battery to the patient
%orrect !nswer) Invaded the patient5s privacy
ationale) Invasion of privacy is a violation of a person5s right to protection against unreasonable and
unwarranted interference with his personal life. !n exa"ple of this is disclosure of "edical facts to
persons not entitled to those facts. @reaching the patient5s confidentiality would be providing
infor"ation that is included in the patient5s "edical record. !ssault "eans the patient was touched in
an offensive* insulting* or physically injurious "anner. @attery is the actual contact with another
person or the person5s property.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) .

Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2-. ! patient consents to having a cardiac catheteri3ation and willingly per"its the nurse to draw blood
and "easure vital signs before the procedure. 2he patient5s per"itting the actions of the nurse would
be considered as which of the following7
1. I"plied consent
2. Infor"ed consent
$. E"ergency doctrine
&. !cceptance
%orrect !nswer) I"plied consent
ationale) I"plied consent is consent that "ay be inferred by the patient5s conduct or that "ay legally
be presu"ed in e"ergency situations. Many patients hold out their ar" and roll up their sleeve when
the nurse approaches with a stethoscope and blood pressure cuff. 2his is an exa"ple of i"plied
consent because a reasonable person would infer by the patient5s action that the patient is consenting
to the procedure. Infor"ed consent "eans the patient received infor"ation needed to "a#e a
#nowledgeable decision about a "edical procedure or treat"ent4 there is no infor"ation in the
scenario about the patient5s receiving the infor"ation. E"ergency doctrine is when consent for
treat"ent is i"plied and delaying care would result in the loss of life or li"b. !cceptance is not a
concept of consent.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 11
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
2.. ! patient is in the operating roo" holding area and tells the nurse that he changed his "ind and
does not want the procedure. 6hich of the following should the nurse do7
1. %ontact the surgeon and i"ple"ent steps to cancel the procedure.
2. Explain to the patient that he has already "ade his decision and cannot change his "ind.
$. !s# the surgeon to explain to the patient why he needs the surgery.
&. (ocu"ent that the preoperative anesthesia has "ade the patient confused.
%orrect !nswer) %ontact the surgeon and i"ple"ent steps to cancel the procedure.
ationale) Infor"ed consent includes the patient having the right to refuse treat"ent even after the
procedure or therapy has started. 2he nurse should contact the surgeon and i"ple"ent steps to cancel
the procedure. 2he nurse should not tell the patient that he cannot change his "ind* nor should the
surgeon be called to persuade the patient to continue with the procedure. 2he nurse should not falsely
docu"ent that the preoperative anesthesia has "ade the patient confused.
%ognitive Level) !pplying
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 11
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
$1. ! patient /uestions why his leg is being shaved if he is scheduled to have open0heart surgery.
6hich of the following should the nurse do in this situation7
1. %ontact the health care provider because the patient is not co"pletely infor"ed about the
procedure.
2. Explain that the leg veins will be used for the surgery.
$. 2ell the patient that the doctor wrote an order to shave his leg.
&. (ocu"ent that the patient refused to have his leg prepped prior to surgery.
%orrect !nswer) %ontact the health care provider because the patient is not co"pletely infor"ed about
the procedure.
ationale) 2he nurse has the responsibility to contact the health care provider because it was obvious
that the patient does not understand everything about the open0heart surgery procedure. 2he nurse
should not supple"ent infor"ation provided* nor should the nurse state that the health care provider
wrote the order to have the leg shaved. 2he nurse should also not docu"ent that the patient refused to
have his leg prepped prior to surgery* but should contact the surgeon to provide additional infor"ation
so the patient can provide infor"ed consent.
%ognitive Level) !naly3ing
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 11
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
$1. 2he nurse is providing care to a patient who has a history of suing health care providers. 6hich of
the following can the nurse do to reduce the ris# of a lawsuit7
1. Establish co""unication and trust.
2. ;pend as little a"ount of ti"e with the patient as possible.
$. (elegate care activities to an unlicensed assistant.
&. ;witch the assign"ent with another nurse.
%orrect !nswer) Establish co""unication and trust.
ationale) One of the "ost funda"ental aspects of "alpractice law involves relationships. ?or a duty
to be owed the patient* one "ust first establish that a nurseFpatient relationship exists. 2his "ay be
acco"plished by showing that a reliance relationship exists) One person Cthe patientD is depending on
another person Cthe nurseD for co"petent* /uality nursing care. 2he core of any reliance relationship is
trust and co""unication. Establishing rapport with a patient* infor"ing patients honestly and openly
of all aspects of their care* and allowing patients to "a#e decisions for the"selves have always been
credited to nurses as one "eans of preventing potential liability. 8ursing is a caring profession4 part of
caring is "aintaining co""unications and ensuring that trust is established and continues throughout
the interactions between the nurse and the patient. 2he nurse should not reduce the a"ount of ti"e
spent with the patient nor delegate activities to an unlicensed assistant. 2he nurse should also not
switch the assign"ent with another nurse.
%ognitive Level) !naly3ing
8ursing 9rocess) 9lanning
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 11
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
$2. ! patient tells the nurse that she does not want to ta#e a particular "edication but does not want to
tell the doctor because =he will be angry with "e.> 6hich of the following should the nurse do to help
this patient7
1. Encourage the patient to spea# to the health care provider on her own behalf.
2. 2ell the patient that the doctor does not need to #now.
$. Offer to give the infor"ation to the doctor.
&. 2ell the patient that if she does not ta#e the "edication* she "ight have "ore troubles in the
future.
%orrect !nswer) Encourage the patient to spea# to the health care provider on her own behalf.
ationale) Encouraging the patient to spea# to the health care provider on her own behalf is an
exa"ple of the values0based decision "odel of advocacy. 2he nurse should not encourage the
withholding of the infor"ation fro" the health care provider. 2he nurse should not offer to tell the
health care provider for the patient. 2he nurse should also not threaten the patient by saying if she does
not ta#e the "edication she "ight have "ore troubles in the future.
%ognitive Level) !pplying
8ursing 9rocess) I"ple"entation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 11
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.
$$. ! patient who fell when being transferred fro" the bed to a chair tells the nurse that he does not
plan to contact an attorney because the nurse told hi" to do the transfer one way and he insisted on
doing it another and reali3es that it was his fault that he fell. 2his is an exa"ple of which of the
following7
1. 2rust and co""unication between the nurse and patient
2. 9reventative co""unication
$. I"plied consent
&. Infor"ed consent
%orrect !nswer) 2rust and co""unication between the nurse and patient
ationale) 2he core of any reliance relationship is trust and co""unication. Establishing rapport with
a patient* infor"ing patients honestly and openly of all aspects of their care* and allowing patients to
"a#e decisions for the"selves is one way to prevent potential liability. 2here is no such concept as
preventative co""unication. I"plied consent "eans a patient per"its an action based upon the
patient5s conduct or behavior. Infor"ed consent "eans a patient has been provided with all necessary
infor"ation so as to "a#e a decision about a plan of treat"ent or care.
%ognitive Level) !naly3ing
8ursing 9rocess) Evaluation
%lient 8eed) ;afe* Effective %are Environ"ent
LO) 11
Osborn, et al., Test Item File for Medical-Surgical Nursing:
Preparation for Practice Copyright 2010 by Pearson Education, Inc.